In the final installment of my 3-part ACL blog, I’ll finally touch on ways to reduce the risk of ACL injuries. While there have been several neuromuscular warm-up programs to reduce the incidence of ACL tears, this blog will focus on the evidence surrounding the FIFA 11+.

So how do we prevent ACL ruptures from occurring?

Barengo et al. (2014) stated that the majority of time lost in professional soccer is associated with modifiable risk factors. Non-contact injuries can best be prevented by thorough preparation.

What is the FIFA 11+?

The FIFA 11+ is an injury prevention program developed by an international group of experts. It consists of a complete warm-up program meant to replace a team/individual’s usual warm up and aims to reduce injuries among male and female soccer players aged 14+.

The FIFA 11+ is split into 3 parts:

Part 1: running exercises at a slow speed combined with active stretching and controlled partner contacts;

Part 2: six sets of exercises with 3 varying difficulty levels, focusing on core and legs strength, balance, and plyometrics/ agility

Part 3: running exercises

*a link to the exercises and field set up are at the bottom of this blog

Frequency

It is recommended that the program be performed as a standard warm up, at the start of each training session at least twice a week. Parts 1 and 3 should be performed prior to matches.

EVIDENCE

Risk Reduction

Teams that performed the FIFA 11+ regularly at least 2x/week had 37% fewer training injuries and 29% fewer match injuries (Soligard et al., 2008). A recent systematic review concluded that teams that implemented the FIFA 11+ had anywhere from 30-70% reduction in the number of injured players. It was also noted that the FIFA 11+ reduced not only severe injuries but also overuse injuries and injuries overall (Soligard et al., 2008).

It is suggeseted that a trained individual (coach, health care practitioner) supervise the program and correct the players if necessary. Bizzini et al. (2013) recommends that the program be taught to coaches in a workshop that consists of theoretical background knowledge and practical demonstration of the exercises. A study by Steffen et al. (2013) showed that compared to an unsupervised group, single leg balance and anterior SEBT (star exercursion balance test) improved significantly with on-field supervision of the program. Furthermore, they stated that coaches who had been educated during an extensive preseason workshop were associated with greater team adherence to the program and decreased injury risk compared to unsupervised delivery methods.

Adherence

Soligard et al. (2010) found that positive attitudes towards injury prevention correlated with high compliance and lower injury risk. Higher compliance had a 35% risk reduction of all injuries and had significant improvements in neuromuscular control and motor performance when executed 1.5times/week (Barengo et al, 2014, Steffen et al., 2014).

SUMMARY

Neuromuscular warm up programs such as the FIFA 11+ can:

Reduce the risk of injury

Improve strength, proprioception, vertical jump height and speed

Supervised programs have better results than unsupervised

A positive attitude towards injury prevention is important for compliance which in turn lowers injury risk

While the FIFA 11+ is a good generic program shown to reduce injury risk (specifically in soccer players), it’s important to remember every athlete has different requirements. For example, a higher-level player may require additional loading progressions secondary to their greater baseline neuromuscular performance (Barengo et al., 2014). In addition, it’s cross applicability into other sports is yet to be determined.

So what’s my biggest take home message from these blogs? DO A PROPER WARM-UP regardless of the league you are in. As someone that has transitioned from a competitive playing environment into a fun, recreational league, my warm-up has also dwindled. Prior to my injury I would show up 15 minutes early, do a couple toe touches and run one width of the field. Since my injury, I’m the player that’s in the corner of the field doing the FIFA 11+ by myself. I may look silly and miss out on the latest gossip, but I definitely don’t want to go through 15 months of rehab ever again.

*If you would like more information regarding the FIFA 11+, you can go to:

The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review. Int J Environ Res Public Health. 2014;11(11):11986-2000.

Bizzini, M., Junge, A., Dvorak, J. Implementation of the FIFA 11+ football warm up program: How to approach and convince the Football associations to invest in prevention. Br J Sports Med. 2013;47(12):803-806.